Active NPI
Theresa Aileen Muday, MD
- Family Medicine Physician
- Coos Bay, OR
National Provider Identifier
1639154875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD22695
- Practice address
- 1900 Woodland Dr
Coos Bay, OR 97420-0000 - Phone
- (541) 267-5151
- Fax
- (541) 266-4501
- NPI assigned
- Dec 9, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD22695 | OR | Primary |
Addresses
Primary practice location
1900 Woodland Dr
Coos Bay, OR 97420-0000
Mailing address
1900 Woodland Dr
Coos Bay, OR 97420-0000
Phone (541) 267-5151
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407812365 | Other | OR | NBMC NPI NUMBER-GROUP |
| 165468 | Medicaid | OR | |
| CD8723 | Other | OR | RR MEDICARE GROUP NUMBER |
| 0577260001 | Other | OR | DMERC NUMBER |
| R0000WFBTV | Other | OR | MEDICARE GROUP PIN NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD22695 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193356800000",
"number": "1639154875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 WOODLAND DR",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974200000",
"telephone_number": "541-267-5151",
"fax_number": "541-266-4501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 WOODLAND DR",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974200000",
"telephone_number": "541-267-5151",
"fax_number": "541-266-4501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUDAY",
"first_name": "THERESA",
"middle_name": "AILEEN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-09",
"last_updated": "2007-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD22695",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NBMC NPI NUMBER-GROUP",
"identifier": "1407812365",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "165468",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP NUMBER",
"identifier": "CD8723",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC NUMBER",
"identifier": "0577260001",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PIN NUMBER",
"identifier": "R0000WFBTV",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.